Essential tremor is a common movement disorder that is also referred to as hereditary or familial tremor, or benign essential tremor.

The tremor in essential tremor often involves the hands, head, and voice, but can sometimes impact the legs or other body parts as well.

Symptoms are typically most noticeable when trying to hold the hands outstretched, or doing something purposeful like pouring liquid, writing, or using utensils.

The tremor often subsides with rest or relaxation.

Essential tremor usually develops in adulthood and gradually worsens over time, so that it can reach a point where treatment with medication may be appropriate.

What causes essential tremor?

The cause of essential tremor is not fully understood, but there is often a history of similar tremors in other family members. Essential tremor is thought to arise in the brain, though not on a scale that can be detected with a brain scan. Brain structures including the thalamus and cerebellum have been implicated but appear normal on imaging studies.

How is essential tremor diagnosed?

The diagnosis of essential tremor is based on the appearance of the tremor, the duration of symptoms and the response to treatment. There is no specific diagnostic test for essential tremor, although sometimes blood work is done to rule out other conditions that may worsen the tremor, like hyperthyroidism. Many patients with essential tremor also notice a reduction in symptoms after consuming alcohol, though this is not a recommended management strategy.

How is essential tremor treated?

There is no cure for essential tremor, but coping strategies including weighted utensils or wrist weights can be helpful for some patients. Some medications used for other conditions can worsen essential tremor, and may need to be reduced or eliminated. Medications that can be used to treat essential tremor include:

Beta-blockers, specifically propranolol

Anti-seizure medications, such as primidone, topiramate, gabapentin and clonazepam

Some patients with severe tremor that cannot be controlled with medication may be eligible for surgical treatment of their tremor. Surgical treatments include:

Deep brain stimulation (DBS), where a thin wire is placed into one or both sides of the brain, into a structure called the thalamus, and connected to a pacemaker-like device in the chest. This can interrupt the electrical circuit causing the tremor and reduce symptoms.

Thalamotomy, where a small lesion or scar is made in the brain to interrupt the tremor. This is typically only done on one side, to reduce symptoms in the dominant hand.